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What is aortic valve stenosis?

Aortic valve stenosis—one of the more serious and most common valve diseases in the United States—occurs when the heart's aortic valve narrows, preventing the valve from opening fully. Blood flow into the main artery of the body (aorta) is blocked or reduced, and the heart is forced to work harder as it pumps blood to the body. Symptoms associated with severe aortic stenosis include shortness of breath, chest pain or tightness, fainting, dizziness and palpitations or heart pounding.

Dr. William R. Davis, MD
Cardiologist (Heart Specialist)

The aortic valve, one of the four heart valves that, as in any "hydraulic" system, determines flow of, in this case, blood. The aortic valve, more so than any other heart valve, is subject to a wear-and-tear process that can lead to deterioration. This usually develops in someone's 60s, 70s and later in life (though a congenital form can show in your 30s).

The condition is generally diagnosed with an echocardiogram that generates two values: an aortic valve area (normal is 2.5-3.0 square centimeters) and a peak gradient (normal <10 mmHg). Typically, this is tracked, e.g., an echo every year. The conventional solution is to watch you until you begin having symptoms or, less commonly, when the valve shows severe reduction in area below 1.0 square centimeter or the peak gradient becomes very high. If symptoms such as chest discomfort, breathlessness or lightheadedness appear, then virtually all cardiologists and cardiothoracic surgeons agree that surgical replacement is advised.

However, let me tell you about an experience I have had with around 70 aortic valve stenosis patients (though I have not yet had an opportunity to publish this experience, so you will not find this confirmed anywhere). When I started having my patients restore vitamin D blood levels (25-hydroxy vitamin D) to a level of 60-70 ng/ml (150-180 nmol/L), the majority of people had valves that stopped getting worse year after year. This is not supposed to happen, as the valve area is expected to drop around 0.1-0.2 square centimeters each year. Having watched these people for up to 8 years, I am now convinced that this is genuine effect. The majority of people require 8000-12,000 units per day as a vitamin D3 gelcap, meaning people with this conditon appear to require more than the average person, perhaps part of a package of genetic tendencies. Of those 70, a few have gotten worse, while a few actually regressed, i.e., had an increase in aortic valve area. Beyond this, though less critical, attention to NOT taking a calcium supplement while supplementing vitamin K2, another nutrient important in calcium metabolism, seems to be slightly helpful, e.g., 180-200 mcg of the MK-7 form of vitamin K2.

While my experience is preliminary and needs to be confirmed in a formal clinical trial, these treatments are benign. An occasional 25-hydroxy vitamin D blood level is also very helpful, e.g., every 6 months.

Aortic stenosis is a condition most commonly seen in the elderly population because of wear and tear of the valve. The valve becomes thickened and calcified, and it does not open normally. This causes patients to get short of breath, limiting their activities. If the condition is untreated, eventually patients will go into heart failure.

The traditional treatment for aortic valve stenosis is valve replacement, which is an open heart surgery. However, elderly patients have many other comorbidities, which prohibit heart surgery.

If a patient is high risk, then he or she can qualify for the non-open heart surgical transcatheter aortic valve replacement (TAVR) and get his or her valve replaced.

Dr. Abdul J. Tajik, MD
Cardiologist (Heart Specialist)

Aortic stenosis is a narrowing of the aortic valve opening. The aortic valve separates the left ventricle from the aorta, and normally has three leaflets, which open and close as the ventricle contracts. The narrowed passageway makes it difficult for blood to be pumped out of the left ventricle to the rest of the body. This puts added stress on the heart muscle and it begins to thicken. Eventually, this additional work can weaken the heart and cause symptoms to develop.

In aortic valve stenosis, the aortic valve becomes narrowed and does not open fully. This decreases blood flow from the heart to the rest of the body.

As the aortic valve narrows, the left ventricle has to work harder to pump blood out through the valve. To do this extra work, the muscles in the ventricle walls become thicker. This can lead to problems over time.

This content originally appeared online in "The Patient Guide to Heart, Lung, and Esophageal Surgery" from the Society of Thoracic Surgery.

Aortic valve stenosis occurs when calcium is deposited on the valve leaflets, which makes them immobile and decreases their opening. This results in the heart working harder to pump out a smaller amount of blood to the body. Over time, the opening of the valve becomes smaller and smaller, and the heart cannot pump enough blood to the body, resulting in symptoms of shortness of breath, chest pain and dizziness. Aortic valve stenosis is associated with older age and cannot be reversed or treated with medications.  

Dr. Joseph E. Bavaria, MD
Cardiothoracic Surgeon
When the heart pumps, blood exits the heart and is pumped into a large blood vessel (called the aorta). The aortic valve acts as a one-way gate, allowing blood to exit the heart to go into the aorta and then to the rest of the body. Aortic stenosis refers to the narrowing of this valve, restricting the valve’s ability to open and allow normal blood flow. When this valve has narrowed to a certain extent, it is referred to as severe aortic stenosis.
Dr. Daniel P. O'Hair, MD
Cardiothoracic Surgeon

The most common heart valve condition is aortic stenosis. The aortic valve is the last valve blood passes through before it goes to your arms and legs and brain and everywhere else in your body. In some patients, that valve starts to narrow. Instead of being as round as a silver dollar it is like a dime, which limits the flow of blood.

When patients with aortic stenosis are active, their heart is pumping hard, but it is pumping against an obstruction or partial obstruction. The condition is more common in elderly patients.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

Aortic valve stenosis means the valve that opens to let blood flow from the heart to the rest of the body is narrow and doesn’t open all the way. Watch this animation to see how aortic valve stenosis happens.

Aortic valve stenosis is also called aortic stenosis or AS. It is a disease of the aortic valve in the heart. Valves act as doors between the heart chambers. They open and close to direct blood flow through the heart. The aortic valve lies between the left ventricle (lower chamber) and the aorta.

The aorta is a blood vessel that supplies blood to your head and your body, including the heart muscles. The aortic valve is made up of three cusps (flaps) attached to the aortic ring. The cusps come from the sides and top of the valve and meet in the middle. As the heart beats, the aortic valve opens to let blood flow into the aorta. When the heart rests between beats, the aortic valve should close to keep blood from flowing back.

Aortic stenosis happens when the cusps get thick and stiff. Stenosis means the valve opening gets smaller. When you have aortic stenosis, your heart works harder to push blood through the thick, stiff aortic cusps. Over time, the cusps cannot open wide enough to allow adequate blood to flow from your heart into your aorta.

Aortic valve stenosis is when the valve leaflets between the heart and aorta (the main artery leading away from the heart) have narrowed and do not permit enough blood to exit the heart and travel to the rest of the body. A valve can narrow because the flaps have grown thick or stiff or have grown together.

Your physician may prescribe several types of medication to help treat the symptoms of aortic valve stenosis. Possible medications include diuretics to reduce fluid retention in the body, anticoagulants or “blood-thinners” to discourage blood clots and medications to control the heart’s rhythm.

If your aortic valve is seriously narrowed, your physician may recommend surgery or a procedure called valvuloplasty to stretch the valve open. Surgery for aortic valve stenosis consists of valve replacement either with a mechanical valve or a tissue valve from a human, pig or cow. If valvuloplasty is indicated, a cardiologist will thread a tube called a catheter through a vein in the groin, and through your artery to the site of the valve. A small balloon attached to the catheter will open and close, stretching the valve and improving blood flow.
 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.